Atrophic Maxilla Reconstruction With Autogenous Iliac Graft and Guided Dental Implants.

Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.

Does early exercise attenuate muscle atrophy or bone loss after spinal cord injury?

OBJECTIVES: To systematically identify and assess the evidence on the efficacy of exercise initiated early after traumatic spinal cord injury (SCI). METHODS: A comprehensive search (Any-2014) of eleven databases identified studies evaluating exercise interventions initiated within 12 weeks after SCI on muscle and bone loss in paralyzed limbs and comparing with standard care or immobilization. Two reviewers assessed methodological quality. One reviewer extracted data and critiqued results according to the Spinal Cord Injury Rehabilitation Evidence body of evidence framework. RESULTS: A total of 2811 titles were screened. Eleven studies were included: five randomized controlled trials, four cohort studies and two within-subject control studies. All provided level II evidence with a moderate risk of bias. Two studies found significant positive effects of high-load FES-resisted stance on physiological measures of muscle. Three reported positive effects of 3 months of Functional Electrical Stimulation (FES) on muscle size. Two studies found positive effects of 6-month body-weight supported treadmill training or FES on trabecular bone using pQCT. CONCLUSION: We found consistent evidence of positive effects of early exercise on muscle, possibly related to load intensity of the protocol. However, the heterogeneity of interventions and outcomes makes this determination speculative. Evidence for the effectiveness of early exercise on bone is scant and confined to measures of trabecular bone mineral density via pQCT. Transparent reporting of methods and variability of data, combined with standardization of valid and sensitive measures of muscle atrophy and bone loss, could facilitate future meta-analysis on this topic.

Bone structure and density via HR-pQCT in 60d bed-rest, 2-years recovery with and without countermeasures.

We examined the effects of bed-rest, recovery and exercise countermeasures on bone density and structure at the distal tibia and radius as measured via high-resolution peripheral computed tomography. 24 subjects underwent 60-days of head-down tilt bed-rest and performed either resistive vibration exercise (RVE; n = 7), resistive exercise only (RE; n = 8) or no exercise (n = 9; 2nd Berlin BedRest Study; BBR2-2). Measurements were performed regularly during and up to 2-years after 60d bed-rest. At the distal tibia marked reductions in cortical area, cortical thickness and bone density but increases in periosteal perimeter and trabecular area were seen (p all<0.001). Recovery of most parameters occurred within 180d after bed-rest. At the distal radius, persistent increases in cortical area, cortical thickness, cortical density and total density and decreases in trabecular area were seen (p all ≤ 0.005). A significant effect of RVE (p = 0.003), but not RE, was seen on cortical area at the distal tibia, with few effects of the countermeasures observed on the remaining parameters. The current study represents the first implementation of high-resolution peripheral computed tomography in bed-rest in male subjects and helps to understand the patterns of bone remodeling due to bed-rest and recovery.

Ultrashort sintered porous-surfaced dental implants used to replace posterior teeth.

BACKGROUND: This retrospective multicenter report provides data from a case series of partially edentulous subjects treated with an ultrashort (5-mm-long) sintered porous-surfaced (SPS) dental implant. METHODS: The implant used had a tapered truncated cone shape, was 5-mm long, and had a maximal coronal diameter of 5 mm. Twenty-six implants were placed in 20 subjects to replace primarily maxillary and mandibular molar teeth. Submerged primary healing was used. Nine implants were restored with single crowns, one carried a single cantilever, and the remaining 16 implants were part of fixed implant-supported bridges, generally as the most distal abutment. RESULTS: After functional periods of 1 to 8 years, two maxillary implants failed, giving maxillary and mandibular failure rates of 14.3% and 0%, respectively. CONCLUSION: The results of this case series suggest that an SPS, press-fit, tapered dental implant with a length of 5 mm and a maximal coronal diameter of 5 mm should be investigated further as a solution for the management of highly resorbed posterior sites in partial edentulism, particularly in the mandible.

One-year outcome of narrow diameter blasted implants for rehabilitation of maxillas with knife-edge resorption.

OBJECTIVES: This study aimed at assessing the clinical outcome of narrow diameter implants in the treatment of knife-edge edentulous maxillas of adequate bone height but inadequate width (class IV of Cawood and Howell). MATERIAL AND METHODS: Twelve consecutive patients (eight women and four men, mean age 58 years) with class IV atrophic edentulous maxillas were included in the study. Seventy-three microthreaded TiO(2)-blasted implants were placed and the resonance frequency measured. All the implants had a diameter of 3.5 mm. After 6 months of submerged healing, fixed implant-supported prostheses were delivered to the patients and resonance frequency and radiographic examinations performed. After the first year of loading, the implant outcome was again evaluated clinically, radiographically and with resonance frequency analysis. RESULTS: All the implants were followed up to 1 year of loading and their survival rate was 100%. Bone loss after 1 year of loading was (mean+/-SD) 0.30+/-0.13 mm. Stability values were (mean+/-SD) 63+/-5.8 ISQ at placement, 60+/-4.7 ISQ at the abutment connection and 61+/-5 ISQ after 1 year of loading. A significant difference resulted between placement and abutment connection values (P=0.03). CONCLUSIONS: According to the present study, narrow implants may be used to restore edentulous maxillas with atrophies of class IV of Cawood and Howell. When planning the treatment of edentulous maxillas with such a resorption pattern, this possibility has to be considered as an alternative to more demanding grafting techniques.

La pérdida ósea marginal en la rehabilitación fija con implantes en pacientes edéntulos. Un estudio a 3 años / Marginal bone loss on fixed rehabilitation with implants in edentulous patients. A 3-year study

Introducción: El objetivo del presente estudio era mostrar los resultados de la pérdida ósea marginal en el tratamiento con rehabilitación fija mediante implantes dentales en pacientes edéntulos totales. Material y Métodos: 24 pacientes edéntulos fueron tratados con 210 implantes KTX ® con superficie arenada y grabada para la rehabilitación total fija. Los implantes fueron cargados inmediatamente en el mismo día de la cirugía. El seguimiento clínico medio fue de 37,1 ±14,6 meses. Resultados: Los hallazgos clínicos indican una supervivencia y éxito de los implantes del 99,5%. Los pacientes fueron rehabilitados con 33 prótesis totales fijas atornilladas. Complicaciones biológicas fueron observadas en el 50% de los pacientes y las complicaciones prostodóncicas en el 4,2% de los pacientes. La pérdida ósea marginal fue de 1,33± 0,77 mm. La pérdida ósea marginal no estuvo relacionada significativamente con la edad, sexo, hábito de fumar, antecedentes médicos, tipos de prótesis y seguimiento clínico. Conclusiones: Este estudio indica que la rehabilitación fija mediante implantes dentales en pacientes edéntulos totales constituye una terapéutica con éxito con una pérdida ósea marginal frecuente. (AU)

Introduction: The aim of this study was to report the outcome of marginal bone loss in the treatment of fully edentulous patients with fixed prostheses supported with dental implants. Material & Methods: 24 edentulous patients were treated with 210 KTX ® sandblasted and acid surface implants for fixed maxilla/mandible rehabilitation. Implants were immediately loaded in the same day of the surgery. The mean follow-up was 37.1 ±14.6 months. Results: Clinical results indicate a survival and success rate of implants of 99.5%. One implant was lost during the follow-up period. The patients were restored with 33 screw fixed rehabilitations. Biological complications were observed in 50% of patients and technical complications in 4.2% of patients. Mean marginal bone loss was 1.33 ± 0. 77 mm. Marginal bone loss are not significantly related with age, gender, smoking, medical background, types of prostheses, and clinical follow-up. Conclusions: This study indicates that fixed rehabilitations by dental implants in totally edentulous patients constitute a successful treatment with a frequent marginal bone loss. (AU)

Rehabilitation of severely resorbed maxillae with zygomatic implants: an update.

Studies highlight the zygomatic bone as a suitable anatomical structure for implant placements since they cross four corticals. Zygomatic implants were described by Branemark in 1988, since then zygomatic implants are indicated in maxillae with atrophy of the posterior area. They have been used in systemic diseases associated with bone loss in this area, and in patients who have suffered radical surgery for maxillofacial tumors. Computed tomography is recommended before placement in order to discount any pathology of the maxillary sinus. The surgical technique has been slightly modified since its description with procedures such as the sinus slot technique. The success rate obtained by different authors varies between 82% and 100%, indicating this technique as a valid treatment option. The objective of this study was to revise the literature with the aim of updating the subject.

Management of a patient with a failed transmandibular implant.

UNLABELLED: The Transmandibular Implant System (TMI) had been developed in order to provide a patient with a severely resorbed mandible with a stable and retensive implant-supported overdenture. Failure of the transmucosal posts may necessitate removal of the transmandibular implant in total and treatment with an implant-supported prosthesis. The purpose of this paper is to describe overcoming failure of a transmandibular implant without removal and synchronous placement of endosseous dental implants in the interforaminal region, providing an implant-retained overdenture to the patient. CLINICAL RELEVANCE: Transmandibular implants are rarely used nowadays and management of a failed transmandibular implant is reported even less often. Where bone height is adequate, dental implants may be placed in the anterior mandible, even when the failed transmandibular implant is not completely removed.

Safety of zygomatic bone harvesting: a prospective study of 32 consecutive patients with simultaneous zygomatic bone grafting and 1-stage implant placement.

PURPOSE: The purpose of this prospective study was to evaluate the safety of zygomatic bone harvesting and to determine whether a particulated zygomatic bone graft can be used simultaneously with 1-stage dental implants to reconstruct resorbed edentulous alveolar ridges. MATERIALS AND METHODS: Altogether, 82 dental implants were placed in 32 patients. Particulated bone grafts harvested from the zygomatic process were used in 72 of the implant sites. The volume of bone harvested, intraoperative complications, morbidity, and complications on follow-up visits were recorded. Implant survival was examined prospectively. RESULTS: As a harvest site, the zygoma yielded enough bone to complete the reconstructions in each case. The average zygomatic bone graft volume was 0.90 mL (SD 0.30). Perforation of the maxillary sinus occurred at 11 zygomatic sites. None of these perforations led to postoperative problems. No paresthesias or other complications were noted during follow-up examinations. Mean duration of postoperative swelling was 4.5 days, and patients used pain medication for a mean duration of 4 days. After the mean follow-up period of 26.9 months postplacement, 80 of 82 implants were osseointegrated (survival rate 97.6%). DISCUSSION: [corrected] Zygomatic bone is an alternative donor site for bone harvesting with low morbidity. The bone graft yielded is sufficient for use in 2 to 3 implant sites. CONCLUSIONS: The zygoma was a safe intraoral bone harvesting donor site in this patient population. Further, the use of simultaneous particulated zygomatic bone grafts and 1-stage implant placement appears to be an effective procedure.

The Marius implant bridge: surgical and prosthetic rehabilitation for the completely edentulous upper jaw with moderate to severe resorption: a 5-year retrospective clinical study.

BACKGROUND: Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. PURPOSE: Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. MATERIALS AND METHODS: The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. RESULTS: The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. CONCLUSIONS: Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. key words: clinical follow-up, complete arch, double structure, esthetics, maxilla, phonetics, tilted implants

Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures.

A total of 876 consecutively placed fixtures ad modum Brånemark was followed in 268 partially edentulous jaws of 244 patients treated between April 1968 and the end of December 1988. A total of 24 of 712 fixtures exposed at the abutment connection was lost (3%); the continuous prosthesis stability rate was 98.7%, as only four of 293 prostheses were removed. The results of the study indicate the possibility for the Brånemark osseointegration technique also to be used in the treatment of partial edentulism.

A revised technique for stage-two surgery in the severely resorbed mandible: a technical note.

A revised stage-two technique, suitable for the severely resorbed mandible, is described. The objective is to eliminate mucosal mobility around the peri-implant area. This is achieved by means of a technique that limits the detachment of the lingual flap, augments the band of attached masticatory mucosa with a free gingival graft, deepens the vestibule, and prevents the reattachment of the muscles by means of a postsurgical stent.

Treatment concept for mandibular overdentures supported by endosseous implants: a literature review.

Edentulous patients with a severely resorbed mandible often experience problems with their dentures. Treatment concepts involving two to four implants for the support of an overdenture have been proposed. The aim of this study was to develop a treatment concept for mandibular overdentures supported by endosseous implants based on a review of the literature. It is proposed that two implants supporting a mandibular overdenture (bar construction) are sufficient for most applications. Four implants were indicated in situations involving a dentulous maxilla, a narrow mandibular arch, extreme resorption of the mandible (bone height greater than 12 mm), and mandibular soreness and pain.

The cost of dental implants as compared to that of conventional strategies.

The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy, such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are vital in decision making. This paper compares the costs of different treatment strategies in a randomized clinical trial in patients with resorbed mandibles and persistent problems with their conventional dentures: treatment with a mandibular overdenture on permucosal dental implants, an overdenture on a transmandibular implant, new dentures after preprosthetic surgery, and new dentures only. Data were gathered on an individual patient level to gain insight into specific cost episodes. Direct costs were subdivided into labor, material, technique, and overhead. Data concerning these components were gathered during the consecutive treatment phases in the first year. Results show that the resources used to treat a patient with an overdenture supported by a transmandibular implant are seven times those of a complete new set of dentures. Comparison of the cost ratio of an implant-retained overdenture supported by permucosal implants and conventional new prostheses proves less unfavorable: 1:3. New dentures after preprosthetic surgery are almost as expensive as treatment with permucosal implants.

Prosthodontic management of ridge deficiencies.

The treatment goals in prosthodontics and dental laboratory technology are to provide patients with long-term predictable and esthetic outcomes. The periodontal tissues define the framework that will maintain ridge height, thickness, color, texture, and gingival-tooth frame. The loss of teeth, residual ridge resorption and the loss of gingival tissues continue to affect long-term and esthetic treatment outcomes. Prosthodontic treatment requires consideration of the potential negative tissue effect that time and normal biologic change might have on the completed prosthetic design. This article describes alternative restorative solutions for clinical conditions that have traditionally been managed by surgery, removable prosthodontics, or esthetically compromised fixed restorations. Different clinical conditions for tooth-retained and implant-retained fixed partial dentures as well as the laboratory technology describing construction of these different restorations will be discussed.

Computerized tomography with CT models for contemporary ramus frame implant planning and construction.

Loss of bone in the mandible after tooth removal is associated with anatomic and aesthetic complications and instability of the mandibular complete denture. This continuing bone loss is not limited to alveolar bone; portions of the basal bone may also be resorbed. Thus, mandibular complete denture is the most unstable, unretentive, conventional prosthesis fabricated in routine dental practice. Root-form endosteal implants cannot always be placed in advanced atrophic mandibles without autogenous bone grafting (from either the iliac hip crest or another site) or bone regeneration. The ramus frame implant (RFI) is indicated when the atrophy in the mandible is advanced. An RFI is an immediate, totally implant-supported prosthesis, which can use homologous grafting material and platelet-rich plasma for increased bone regeneration. The third-generation RFI provides all of the benefits of the first- and second-generation RFIs as well as improvements provided by computed tomography and computer-aided design/stereolithography applications: planning, simplified placement, improved grafting, predictable manufactured components, and retrievability.

[Dental implants: a better anchor for dentures]. / Tandheelkundige implantaten: een beter houvast van een kunstgebit.

Loss of teeth results in resorption of the jaws. As a consequence the denture bearing area progressively reduces, eventually causing loss of retention and stability of the conventional denture. In three patients, two women aged 36 and 37 and a man aged 46, suffering from severe problems with their conventional dentures endosteal implants were inserted in the jawbone. After the healing period the dentist fabricated an implant-retained overdenture. The patients were very satisfied with the final result. Endosteal implants are, especially in the mandible, a reliable treatment modality for a stable implant-retained denture in case of patients suffering from retention problems with their conventional dentures.

Linear occlusion: an alternative tooth form and occlusal concept as used in complete denture prosthodontics.

The purpose of this article is to provide a detailed outline of the clinical and laboratory procedures used in implementing an alternative occlusal scheme and nonconventional mandibular denture border in the treatment of a completely edentulous patient.

Case report: the transmandibular implant system.

This series of case reports outlines the use of the transmandibular implant system to rehabilitate 10 patients with severely resorbed mandibles. The implants were placed according to manufacturers' guidelines with the patient under a general anaesthetic and reviewed bi-annually thereafter. Three patients experienced problems: in two of these this involved the loss of integration of the distal posts, in the other patient the transmandibular implant was removed in its entirety. Distal locking screws became loose shortly after placement in three patients. Prosthetic complications included difficulty in obtaining passive fit of the superstructure in 7 patients and a high long-term maintenance commitment.